<?php
/* @var $this FundusController */
/* @var $model Fundus */
/* @var $form CActiveForm */
?>

<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'fundus-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($model); ?>

	<div class="column">
		<?php echo $form->labelEx($model,'medis_od'); ?>
		<?php echo $form->textField($model,'medis_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'medis_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'media_os'); ?>
		<?php echo $form->textField($model,'media_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'media_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'disc_od'); ?>
		<?php echo $form->textField($model,'disc_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'disc_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'disk_os'); ?>
		<?php echo $form->textField($model,'disk_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'disk_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'cup_od'); ?>
		<?php echo $form->textField($model,'cup_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'cup_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'cup_os'); ?>
		<?php echo $form->textField($model,'cup_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'cup_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'vessels_od'); ?>
		<?php echo $form->textField($model,'vessels_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'vessels_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'vessels_os'); ?>
		<?php echo $form->textField($model,'vessels_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'vessels_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'periphery_od'); ?>
		<?php echo $form->textField($model,'periphery_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'periphery_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'preiprhery_os'); ?>
		<?php echo $form->textField($model,'preiprhery_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'preiprhery_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'macula_od'); ?>
		<?php echo $form->textField($model,'macula_od',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'macula_od'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'macula_os'); ?>
		<?php echo $form->textField($model,'macula_os',array('size'=>5,'maxlength'=>5)); ?>
		<?php echo $form->error($model,'macula_os'); ?>
	</div>

	<div class="column">
		<?php echo $form->labelEx($model,'rx_id'); ?>
		<?php echo $form->dropDownList($model,'rx_id', CHtml::listData(
                Rx::model() ->findAll(), 'id','id'), array('prompt' => 'Select Rx')); 
                ?>
		<?php echo $form->error($model,'rx_id'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'personalinfo_id'); ?>
		<?php echo $form->dropDownList($model,'personalinfo_id', CHtml::listData(

		PersonalInformation::model() ->findAll(), 'id','fname', 'lname'), array('prompt' => 'Select Person')); ?>

		<?php echo $form->error($model,'personalinfo_id'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->